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Knowing yourself helps you get the right health care

Relationships are as important with family and friends as they are with your health provider.

By Drs. Robert MaunderJonathan HunterUniversity of Toronto

Mon., Jan. 18, 2016

Imagine an elixir that was as good for you as exercise if you took it, and as bad for you as smoking if you didn’t. That is how powerful relationships are to our health; they are a potent force for well-being.

Relationships are as important with family and friends as they are with your health provider. Most people have probably never stopped to consider how their “relationship type” might affect the way they seek and experience health care. But studies show this is an important factor in health. Understanding how we relate to doctors will help us to get what we want out of visits. To start, think about which of the following people you most resemble. If you can’t recognize your style, think of what partners say about you. They know.

Terry is very independent. His partner sometimes complains that he won’t open up and avoids commitment. In a similar way, Terry finds the vulnerability that is part of being sick and receiving medical care unattractive. He avoids preventive health-care exams like colonoscopies, underuses health-care services in general, and mistrusts doctors a bit when there is no choice but to accept treatment. Terry is also prone to backaches — maybe from managing tension on his own too much.

Saanvi, on the other hand, likes to be very close to her partner Ananya, who has called her needy at times. Saanvi has been hurt when Ananya didn’t reciprocate that wish. In a way that is similar to her discomfort with being alone, Saanvi approaches health with worry. Every new twinge signals a possible catastrophe. On average, people like Saanvi have more symptoms, see the doctor more often, want more support than the system provides, and may even be more prone to some chronic diseases.

Joo-won is stuck with both of these concerns — neither comfortable with trusting and connection, nor with managing on his own. This unhappy combination can make him feel cornered and alone. It is hard on his mental health as well as on his body.

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Allison is lucky enough to find that independence and connection are not hard to balance. Her comfort zone is larger and her relationship with her body and with the health-care system is easier. Unfortunately, this balance is hard to find; people with Allison’s more secure relationship style are just barely in the majority.

So what you should you do? In the absence of a miracle elixir, understanding your comfort zone can help you structure your health care to play to your strengths.

Super-independent people like Terry can self-manage health, instead of neglecting the whole topic. Remember that not attending the doctor is not the same thing as being healthy. People like Terry should try to engage a health-care provider as a collaboration between equals. Schedule preventive visits in advance; waiting until you think you need an appointment is a recipe for not going at all.

If, like Saanvi, you are too often in the position of needing reassurance that your weird tummy sensation isn’t gastric adenocarcinoma (you know what that is because you Googled it), remember your challenge is as much with fear as with disease. Take a buddy with you to the doctor’s office, and work over time with the same health-care providers to develop trust and consistency.

If you are cornered like Joo-won, feeling that you need an attentive expert but also that it is hard to assert yourself or trust a doctor’s response, you need to pick which trouble to work on first: choose to either increase your confidence and give yourself a voice, or to become more trusting. Work on the easier one, which for most people is confidence. Write down what you need to say when you are feeling calmer and practise it. Try to build health-care relationships over time so that they can grow more comfortable instead of using drop-in clinics.

Unfortunately, the health-care system is full of barriers and discontinuities, but knowing your relationship style gives you an advantage. Since virtually all of care occurs within relationships, knowing how to make the most of these interactions can help you to get more of the good elixir of care, support and expert collaboration.

Robert Maunder and Jonathan Hunter are professors in the Faculty of Medicine’s Department of Psychiatry and psychiatrists at Mt. Sinai Hospital in Toronto. They are the authors of Love, Fear, and Health: How Our Attachments to Others Shape Health and Health Care (University of Toronto Press). Doctors’ Notes is a weekly column by members of the University of Toronto’s Faculty of Medicine. Email doctorsnotes@thestar.ca

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